Knee pain - causes, effective treatment, diagnosis

Everyone experiences knee pain from time to time. This may be the result of sudden movement or a symptom of progressive pathology. The knee joint is the largest and anatomically complex element of the musculoskeletal system. It represents up to 80% of physical weight, which leads to increased physical activity and risk of injury. A large number of capillaries, nerve fibers and muscle tissue make any injury, even minor, extremely painful. Damaged nerves cause an infectious-inflammatory process, which is accompanied by swelling, discoloration of the skin and fever.

As progress progresses, the joint itself, intra-articular fluid and connective tissue are removed in a pathological condition that can have serious consequences - the development of arthritis. A general understanding of the anatomical structure of the knee joint will help you understand which element can cause pain and what measures need to be taken to eliminate the pain.

Anatomical structure

The anterior zone of the joint is formed by the patella, in simpler language - the patella. It is connected to the quadriceps (fascicular) muscle of the thigh, which continues into the patellar ligament and generally forms a ligamentous apparatus, which consists of the following types of fascia:

• Tibial lateral branches (small and large);
• posterior supporting nodes - sickle-shaped, dorsal, middle and lateral;
• articular transverse and cruciate ligaments of the knee.

The most susceptible to injury are the cruciate ligaments - sudden movement, a high degree of rotation, falling with subluxation lead to rupture of the interminimal joints.

Ligaments are divided into two types:

1. Front - they have the function to stabilize the ankle joint, in particular to prevent excessive forward movement. They originate from the back of the large femur, intersect with the posterior ligaments in the knee cavity and attach to the slit between the anterior protrusions of the tibia.
2. Rear - Restrict the lower leg by moving backwards. They start from the front of the upper femur, cross the joint cavity and end between the dorsal protrusions of the tibia.

There is cartilage on the surface of the joint bones. There are menisci at the junction of the tibia and femur - a type of joint sheath that performs a shock-absorbing and stabilizing role.

There are several synovial sacs (three to five) in the knee joint that provide natural lubrication:

• above the knee cap;
• popliteal deep;
• between the tendons in the long thigh muscle;
• subcutaneous patella;
• in the recess below the knee joint.

Thanks to the knee a person can perform a step, flexion, extension within the limits specified by the ligaments.

Causes of pain

Inflammation can develop in the following structures:

• cartilage;
• joint sheath;
• synovial fluid;
• shin bones;
• muscles and tendons around the joint;
• ligament apparatus;
• blood vessels, veins, arteries;
• subcutaneous fat;
• epidermis.

The most common causes of knee pain are:

1. Osteoarthritis is the cause of more than 50% of cases of knee pain. It is characterized by slow, gradual destruction of hyaline cartilage. It can be asymptomatic for a long time and worsen sharply in the second stage. Knee pain occurs due to growing osteophytes that affect nerve endings;
2. Arthritis is an inflammatory pathology that occurs in an acute form. This can be either a separate disease - spondylitis, or a complication of other joint pathologies - osteoarthritis, rheumatism and others. Arthritis is characterized by intense pain accompanied by swelling and redness;
3. Osteochondritis - articular cartilage becomes inflamed over time in degenerative osteoarthritis, mechanical injuries;
4. Periarthritis is a disease that occurs against the background of obesity (more common in women). The pathology affects the tendons, muscles and subsequently passes to the shell of the knee joint. The pain is moderate, pulling (as in sprains).
5. Chondromatosis is the formation of nodules on the hyaline cartilage tissue that eventually spread to the capsule of the knee joint. In this case, pinching of the soft tissues with a large number of nerve cells occurs. As a result, the knee hurts constantly, even during the rest period.
6. Bursitis - the synovial capsule of the knee joint rarely self-inflames, only as a result of injuries or complications from collateral joint diseases, hence the pain.
7. Cellulite - subcutaneous fat can cause pain only in the case of nearby foci of comorbidities. Purulent arthritis, soft tissue abscess can cause inflammatory and painful processes in the protective layer.
8. Dermatitis - the epidermis is affected by infectious pathologies (eczema, erysipelas, psoriasis) or allergic reactions to external stimuli.
9. Osteomyelitis - The bone marrow becomes inflamed due to bacteria that have entered the jelly body along with the lymph flow. It can also be the result of open injuries or complications from surgery.
10. Synovitis - the capsule of the knee joint is most often affected in the elderly over 55 years, as a result of rheumatism or other chronic pathologies. At a young age you can get sick due to a serious injury.

Types of pain depending on the location

Diseases that provoke the development of negative processes also form the type of pain:

• Intense, excruciating pain - reactive arthritis, torn menisci and tendons, bursitis in the acute stage;
• Tolerable but constant pain - synovitis, bursitis in the initial degree;
• Squeezing pain - gonarthrosis, arthrosis;
• Vibrating - degenerative arthrosis, in the stage of deformation of the joints;
• Acute, burning pain - sciatica, bone tuberculosis;
• Sting - osteoporosis, progression of inflammation of the synovial sac, exacerbation of chronic damage to the meniscus;
• Spasms - inflammation in the soft tissues of the knee joint, muscles and tendons;
• Shooting pain - damage to nerve roots.

Diagnostic measures

If you experience severe pain in the knee joints, you should not delay a visit to the doctor, hoping that "everything will pass". Diagnosis at an early stage ensures successful treatment and prevents the development of more serious processes that can cause irreparable damageHealth and quality of life. For an initial consultation you should contact a therapist. After a standard examination he decides to prescribe treatment (which occurs in 70% of cases of complaints of knee pain) or appoint a comprehensive laboratory and hardware examination, withattracting highly specialized specialists.

Running, suspicious pain is examined in different directions:

• Traumatology: in case of suspicion of arthrosis, congenital or acquired dysplasia, joint fracture, sprain, dislocation, radiography, MRI, ultrasound, liquid biopsy in the synovial sac is prescribed to determine where the pain in the knee joint.
• Surgery: cyst under the patella, thrombosis, arthritis with purulent formations, tendon ruptures, menisci, ligaments, stones inside the joint, hemarthrosis, abscesses are diagnosed by ultrasound, fluoroscopy, CT or MRI, blood tests, general and rheumatoid factorcartilage in the knee joint, etc.
• Rheumatology: the exclusion of systemic diseases (lupus erythematosus, rheumatoid arthritis, gout) is carried out with the help of laboratory tests. Complete blood count, hematology, rheumatoid protein, DNA test, uric acid level.
• Neurology and psychiatry: sciatica does not require a long diagnosis. Ultrasound will show muscle tone and sites of inflammation. In the case of mental disorders, when the pain in the knee joint is not confirmed by a single fact, but the patient continues to experience torment (so-called somatic pain), specific tests for mental anomalies are prescribed.

Basic diagnostic methods

The most popular ways to quickly and accurately diagnose knee pain are:

• X-ray - allows you to see the knee joint in several projections and determine the location of the lesion. The images show lesions in the early stages, in particular changes in the bone, synovial sac or the appearance of osteophytes.
• Ultrasound examination - a modern, high-precision examination determines the thickness of the joint membrane, the condition of the ligament structure, the presence of inflammation of any kind and general changes in the knee.
• Doppler - Examination of veins and arteries for aneurysms, plaques and obstructions. Quickly and effectively determines the possible risks and the condition of the inner walls of blood vessels in percentage terms.
• Currently, MRI is the most accurate way to diagnose. It allows you to see a clear, three-dimensional picture of the knee joint, pathological changes in synovial fluid, even a slight deformation of bone tissue and more. It is rarely prescribed due to its high cost and contraindications. It is forbidden to examine patients with implants, metal prostheses and weighing more than 150 kg.
• CT - the principle of action is based on X-rays, but in a more modern way. The images are made in a circular projection, which allows you to get a more accurate picture of the knee joint and thus determine the nature and extent of the lesion.
• Angiography is a method of examining blood vessels for patency by injecting contrast fluid. Determines the functionality of metabolic processes and allows the diagnosis of joint failure in the early stages.
• Complete blood count - prescribed to identify inflammation and pain. The set of indicators can even lead to a trace of specific diseases and identify joint pathologies only at the very beginning of progression.
• Blood for rheumatoid antibodies - also indicates the presence of inflammation, but with a specific, systemic or hereditary nature. For example, to diagnose rheumatoid arthritis, this analysis is taken as a basis.
• Uric acid is an important test to determine the causes of pain and the stage of exacerbation of gout or infectious arthritis. Elevated levels indicate the accumulation of salt deposits in the joints.
• Wasserman's reaction - prescribed for suspected sexually transmitted infections, syphilis, gonorrhea, chlamydia and others. The development of joint diseases against the background of specific diseases or their complications are very common. Therefore, a positive test will allow the correct treatment to be prescribed, taking into account the type of infection.
• Tumor markers - help to identify special substances in the blood that are released from a cancerous neoplasm or its metastases. Thus, synovial sac sarcoma is characterized by the presence of markers of vimentin, cellular external antigen and pancytokeratin.

Treatment of knee pain

Knee pain can be divided into those that require urgent medical attention. And those who are pre-diagnosed. Emergencies include all injuries, fractures, sprains, abscesses, purulent inflammation, hemarthrosis (bleeding in the joint). The symptoms in all cases are identical - unbearable pain, swelling, redness, inability to move, fever in the knee joint and fever.

Treatment is limited to providing first aid until the arrival of the ambulance:

• the leg should be raised - put a rolled roller or a firm pillow;
• put an ice bandage on the knee and change it every 5-10 minutes;
• take an available painkiller.

In all other cases, the treatment is carried out after conducting a thorough examination and establishing the causes. According to the anamnesis, drug therapy, physiotherapy, exercise therapy, massage, homeopathic treatment, local applications, spa breaks and, in extreme cases, surgery are prescribed.

Conservative therapy

Traditional drug treatment of pain includes the following groups of drugs:

1. Anesthetics. To relieve the initial symptoms and relieve the painful condition, you can take simple painkillers sold without a prescription. Severe cases involving loss of mobility and unbearable pain require more serious medications that are prescribed only by a doctor and are prescribed by a doctor.
2. NSAIDs. Helps to quickly relieve inflammation and swelling.
3. Chondroprotectors. Modern drugs, despite the long course of application, provide regeneration of cartilage tissue. The effect is cumulative and long-lasting (up to 10 years, joint pain may not bother after a six-month course, treatable in the early stages).
4. Glucocorticosteroids. Indicated for patients with autoimmune pathologies to reduce the production of the hormone cortisol and stop the development of the disease. Doses and regimens are prescribed by the doctor strictly individually.
5. Immunosuppressants. They suppress the abnormal action of the defense system, thus stabilizing the development of such dangerous diseases as rheumatoid arthritis, lupus erythematosus and vasculitis. They are rarely prescribed, only in the case of an accurate diagnosis and inability to eliminate knee pain in other ways.
6. Hyaluronic acid injections. They are injected directly into the cavity of the knee joint and eliminate pain and lack of synovial fluid. They also contribute to the recovery of hyaline cartilage, thus restoring knee mobility.

Folk recipes

Most people who begin to experience pain in the knee joint, try to eliminate the discomfort with folk methods. You can make lotions, compresses and night applications based on home-made ointments or tinctures. Decoction of herbs, alcoholic tinctures for topical application will help prevent a period of exacerbation and relieve obsessive pain.

The following plants and substances have anti-inflammatory action:

• coltsfoot;
• St. John's Wort;
• oak bark;
• Burdock roots;
• Bay leaf;
• Chamomile flowers;
• marigold;
• White and black kaolin clay;
• Salt and soda solution;
• Honey products.

For example, mix 10 aspirin tablets, pre-crushed, and a glass of liquid honey. Apply a thick layer on the knee in the area of pain. Cover with cling film and wrap with woolen material (scarf), preferably leave overnight. The pain is eliminated after the first application.

In the same way you can apply a clay application where pain occurs. A little olive oil is added to the mixture of clay and water to prevent hardening and strong tightening of the skin.

An effective recipe that includes honey, salt and soda. Mix 1 teaspoon of salt and soda with honey, enough to cover the knee joint. This method performs three actions at once - removes excess fluid, relieves inflammation and pain, enriches with nutrients.

Oak bark in the form of a decoction or alcoholic tincture strengthens blood vessels well, promotes normal blood circulation. For the decoction pour 1 tablespoon of dried bark with 1 cup of boiled water, cook in a water bath for 20 minutes. Soak gauze with decoction and apply on the knee in a warm (not hot) form for 30-50 minutes to eliminate pain in the knee joint. For alcoholic tincture use the same proportions, just replace the water with vodka. Insist in a dark cool place for 10-14 days. Apply in the same way.

By alternating different means and methods, you can keep the disease for a long time, forget about the pain and swelling. The effectiveness of alternative medicine has not been proven, despite the elimination of the primary symptoms - knee pain.

Massage and therapeutic gymnastics for knee pain

The overall traditional treatment necessarily includes therapeutic exercise and massage. Exercise is recommended for all people who have had or have knee injuries diagnosed with arthritis, osteoarthritis and other joint diseases leading an inactive lifestyle (sedentary static work, disability of 1-2 groups, housewives, etc. ).

Gymnastics can be performed independently, at a slow pace and achievable mode. Gradually increase the number of exercises or, conversely, decrease, depending on how you feel.

1. From a lying position or sitting on a chair, slowly bend and spread your legs, do until a state of slight fatigue.
2. Bending the leg at the knee, perform rotational movements with a small amplitude, repeat the same on the second leg.
3. Lie on your back, gently pull the bent at the knees legs to the abdomen.
4. Put a pillow on the chair and sit so that your legs "hang", make circular movements clockwise and counterclockwise.
5. Sitting on a chair, slowly stretch your leg and hold in this position for 2-5 seconds, just as slowly lower it, repeat on the second leg.
6. Stand up straight, straighten your back, slowly bend your leg at the knee and hold in the heron position for a few seconds. If possible, increase the delay time every 2 days.
7. If there are no contraindications and health allows, you can complicate the complex. Place the gymnastic stick at the maximum level that can be reached with the leg bent at the knee. Throw your legs over the "barrier" 10-15 times, then change position.
8. A small complexion for stretching the lower leg also contributes to the rapid recovery of the knee joint. Lean your palms against the wall, bend your right leg at the knee, place your left leg back. The feet rest completely on the floor. Hold the pose for 30 seconds. Change legs.

Regular performance of simple exercises, available to everyone, will give visible results in a month - the pain in the knee joint will cease to bother, joint mobility will improve, swelling will disappear.

The effectiveness of gymnastics will increase significantly if you combine it with a course of massage. This can be either a traditional method of exposure or manual pain therapy. It should only be remembered that only experienced professionals with good recommendations should be trusted to perform such procedures. Otherwise, manual manipulations will not have the slightest effect in the best case, in the worst case they will provoke displacement of the joints and worsen the pathological condition. The massage should be performed periodically, no more than 10 sessions, 25-30 minutes per month. Daily procedures are strictly contraindicated. There should be no knee pain during the session. If discomfort is felt, the procedure should be stopped.

Treatment at home

The treatment of knee pain at home is a prerequisite for outpatient therapy. The patient with all permitted methods should help relieve pain and recover as quickly as possible.

Therefore, for these purposes it is necessary to adhere to certain rules for the treatment of all types of pain:

• Follow all the recommendations of the attending physician - do not forget to take prescribed medications, do gymnastics possible, come in time for physiotherapy.
• Review your diet. Add lots of fresh vegetables, herbs and fruits to your diet. Exclude fatty meats, fried foods and processed foods.
• If necessary, use aids to relieve the load on the knee joint - cane, crutch and other special devices.
• Do not use, without first consulting a doctor, prescriptions of traditional medicine, even time-tested and neighbors. What helps one person may be strongly contraindicated for another.
• During the treatment period, if possible, avoid physical activity and provide bed rest so that the pain does not return (therapeutic exercises are an exception).
• Provide a comfortable place to sleep and rest - orthopedic mattresses, comfortable chairs and armchairs, preferably with small stands so you can comfortably lift your sore feet.
• A light self-massage is allowed. Stroking, rubbing promote blood circulation, thus enriching tissues with oxygen. This eliminates muscle spasm and makes the pain less intense.

Precautions

It is almost impossible to fully insure against injuries, sprains or sprains of the busiest joint in the body. Everyday life obliges you to do your household chores, go to work, etc. In normal activities it is quite possible to get an unexpected injury. But to reduce the risk of developing joint disease is within the power of each person. Leading rheumatologists have developed a number of recommendations that will help protect you from dangerous pathologies:

• Establish and strictly follow a rational regime - work-rest. This is especially true for people whose activities are associated with increased physical activity (athletes, builders, vendors, metallurgists, miners, etc. ).
• Timely treatment and rehabilitation after any infectious diseases. This rule applies even to such "harmless" as acute respiratory infections or seasonal SARS.
• Avoid exposure to low temperatures, currents. Dress according to the weather to prevent hypothermia.
• At the age of 35 it is desirable to undergo a course of treatment with chondroprotectors.
• Carefully monitor your weight. Gaining weight will inevitably increase the strain on the knees, it is worth remembering when eating another muffin.
• To maintain a normal weight, follow the principles of healthy eating. More vegetables and dairy products - less sweet, spicy, salty, fatty and starchy foods.
• Rethink your lifestyle - quitting smoking, alcohol and other toxic addictions will have a positive effect not only on the knee joints, but on life in general. To overcome addictions, you can turn to your loved ones for help - the difficult stage will pass much faster and easier.

Everyone has experienced knee pain, regardless of age, gender or social status. From the first steps the joint is subjected to all kinds of tests - falls, bruises, injuries, sports, hypothermia. However, many people manage to maintain the mobility, health and functionality of the main compound until old age.